The Profit-Making Costs On Our Health

photo: Library of Congress

The profit-motivated US healthcare system not only makes our healthcare more expensive than other industrialized nations, it also changes our our culture and our behavior to make us less healthy.

One of the biggest problems with the American healthcare system is that it is a rigged economic game where you don't know the price of what anything costs, and yet the price of the unavoidable healthcare needs could bankrupt you.

This price blindness is a fundamental flaw in our so called free-market system, but it is far from the only flaw tied to profit-driven healthcare.

Since so many people fear the boogeyman of socialised medicine, let's talk about some of the problems with the alternative system we now suffer through.

As an aside, please don't equate Obamacare or the ACA with socialised medicine -- it is not. The ACA simply required people to get health insurance and required private insurance companies to sell it to them. These companies are still profit motivated and opposed to cooperating with each other for the sake of good patient care.

For profit corporations are poor actors in the healthcare business, and yet we continue to place more of our lives in their greedy hands. Drug companies in particular have finally been exposed to the spotlight as they have cranked up prices on life saving medications just to boost the share on Wall Street and the bonus of the top executives. While a few high profile examples have recently gotten attention of the media, this practice is widespread and continuing unabated.

As Fortune Magazine reported:

More than two-thirds of the 20 biggest pharma companies used price hikes to drive revenue growth in the first quarter of 2016, according to an analysis of corporate filings and earnings statements by the Wall Street Journal. The review also found that drugmakers have been relying on this tactic more and more and raising prices by higher amounts than before despite multiple Congressional inquiries into the practice and proposed reforms to tackle drug costs from President Obama, Hillary Clinton, Donald Trump, and others. The findings underscore the enormous power that the biopharmaceutical industry maintains in a system where negotiations over prices and discounts are stratified across a decentralized mix of private insurers, government health programs, and drug benefit managers.

Yet another way that for profit companies negatively influence our healthcare decisions is through twisting science and lobbying government.

A recent episode of Tom Ashbrook's On Point had an excellent sampling of the horrifying impact on our nation's health.

Investigative reporters have recently uncovered evidence that drug makers lied to doctors to push the aggressive prescription of addictive oxycontin as "less addictive" alternative to drugs on the market. Documents show the drug makers knew this was not true. 

Moreover, these same pharmaceutical companies were responsible for lobbying to implement increasing the aggressive treatment of pain with narcotics. This is where the whole "pain is the 5th vital sign" originated.

Thus doctors in the United States are being penalized for creating an epidemic of narcotic addiction while at the same time their compensation is linked to surveys of patients asking if they got enough pain medication. That's why the United States -- which has only 5 percent of the world's population consumes two-thirds of the world's prescription pain medication.

It's not an accident of culture, but a concerted, planned out lobbying effort on multiple fronts designed to increase demand for a product. Millions of dollars are spent each year to boost demand for a product that is detrimental to the nation's well being.

In the same show, Ashbrook interviews researchers who discovered that a few well placed science papers in the 1960s allowed the sugar industry to divert scientific research away from carbohydrates and toward saturated fats as the cause for chronic health problems.

Of course this lead to the marketing of products with reduced fats and greatly increased the consumption of sugars.

On both issues we see the way our health culture has been altered by the pursuit profits at the cost of American lives.

Required reading:

Secret Trove Reveals Bold Crusade to Make Oxy a Blockbuster

The LA Times Series on the Oxycontin

How the Sugar Industry Shifted the Blame to Fat

To Make Big Profits, Drug Companies Use Monopoly Shenanigans

Drug Rep Arrested in Opiod Kickback Scheme

The whole On Point podcast is available and worth listening to.

Standing in line for my pseudoephedrine

Interesting essay from the Atlantic about the societal costs of curbing access to the cold medicine pseudoephedrine.  It's the latest bouncing around the blogosphere following the introduction of legislation to make an effective cold medicine prescription-only. 
In Do We Need Even Tighter Controls On Sudafed?  Megan McArdle argues that requiring cold suffers to go to their doctor to get a prescription for pseudoephedrine (PSE) creates an unnecessary burden on the health care system when compared with its impact on cleaning up amateur meth labs. 
The author seems to have done some math, but her research into the history and scope of meth appears limited to a few episodes of Breaking Bad. (For an excellent investigation into the history of the current epidemic, I suggest this Oregonian investigation. She states that controls on pseudoephedrine are aimed at controlling meth lab explosions from "amateur" cooks (who cooks meth as a hobby?) in the midwest.
Actually, meth was a long time Northwest phenomenon. For two decades law enforcement officials had trouble getting anyone back East to take it seriously.  I know, because I was a cops and courts newspaper reporter in the days when meth was exploding in the 1990s. These days, I'm on the other front line -- treating meth addicts daily for the toxic effects of abuse.
This is not a case of toxic labs and benign recreational drug -- the drug itself is toxic too. Making tighter controls on the ingredients was originally an effort to make it harder to get the drug, not just more difficult to make. 
Rural communities -- ill funded an ill equipped to do toxic clean up work -- were overwhelmed when meth was home grown. Fragile ecosystems, national parks, wildlife refuges and rural water supplies were contaminated and endangered by meth labs. Oregon's requirement for prescription-only pseudoephedrine helped cut these meth lab incidents down to zero. 
Indeed, controls like those imposed in Oregon and Washington helped create the large scale meth factories in Mexico. This is not a product we want Made in the USA if we can help it. When Mexico banned the main component of meth cooking outright in 2009, production started shifting back to the United States -- this time to places in the country with larger potential markets and less restrictive purchasing of the main ingredient.  
Outside of Oregon, meth cooks have found ways around the registration laws by using proxies and false ID to get PSE in states that don't require a prescription. 
As Oregon lawmaker Rob Bovett recently wrote for the New York Times in an Op-Ed that kicked off the debate:

The only effective solution is to put the genie back in the bottle by returning pseudoephedrine to prescription-drug status. That’s what Oregon did more than four years ago, enabling the state to eliminate smurfing and nearly eradicate meth labs. This is part of the reason that Oregon recently experienced the steepest decline in crime rates in the 50 states.

The problem is that pseudoephedrine is an effective cold medicine where as the replacement ingredient in Sudafed  Phenylephrine (hydrochloride)  is not. That means that some people will go the extra mile to "get the good stuff."  Here is Washington, you have to sign a registry and show ID at the pharmacy counter -- it is embarrassing, but not much of a hassle. I've done it. 
In Oregon, you need a script. Oregon Sen. Ron Wyden is now proposing that the drug be prescription-only nationwide. 
Sure, if you imagine all those cold suffers that currently buy Sudafed over the counter going to their primary care doc to get scripts, that's going to add up. Most folks will just suffer through the cold or buy something else. The companies that make PSE will see profits dry up.
Thus far, however, the authors of this debate fail to mention the societal costs of Meth in realistic terms. Meth addicts make up a substantial population of those treated in the Emergency Room for everything from abscesses, life-threatening infections, meth-induced psychosis and dental pain. 
Making PSE prescription only is an escalation in an arms race over a dangerous and toxic drug with massive societal impacts -- much greater in scale that the profits of a drug company or the comfort of those suffering through a runny nose. 


Required Reading: Unnecessary Epidemic